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M6 13-005

Exam 12: Pediatric Cardiovascular Disorders

Congenital Heart Disease Anatomic abnormalities present at birth that result in abnormal cardiac function.
Acquired Heart Disease Heart disease that occurs after birth.
Heart Disease Physical Assessment Inspecting nutritional state i.e. FTT or poor weight gain, color (cyanosis), chest deformities, unusual pulses (visible pulsations in the neck veins), respiratory status, and clubbing of fingers.
Heart Disease Physical Assessment (Palpate & Percuss) Palpate and percuss chest, abdomen and peripheral pulses paying attention to rate, murmurs and additional heart sounds.
Heart Disease Diagnostic Evaluation ECG. Echocardiography. Cardiac Catherterization. CXR.
Most commonly used Diagnostic Tool used to determine Heart Disease in pediatrics. ECG
Hypoglycemia May occur in patients with polycythemia.
What is a cardiac catheterization? A radiopaque catheter that is passed through the femoral artery or vein directly into the heart and large vessels.
Congenital Heart Disease may be caused by Intrauterine Rubella Exposure. Maternal Alcoholism. Diabetes Mellitus. Advanced maternal Age. Maternal Drug Ingestion. Exposure to environmental toxins and infections. Sibling or parent has history of congenital heart disease. Chromosomal Abnormal
Congenital Heart Disease: Diagnostic Tests (Invasive) ABG. Fluroscopy. Angiography. Cardiac Catheterization.
Congenital Heart Disease: Diagnostic Tests (Non-Invasive) Cardiac magnetic resonance imaging (MRI). Echocardiogram.
Congenital Heart Disease: Clinical Manifestations Cyanosis. Pallor. Cardiomegaly. Pericardial rubs. Murmurs. Additional Heart Sounds (S3 or S4). Discrepancies between apical and radial pulses. Tachypnea. Dyspnea. Grunting. Digital clubbing. Hepatomegaly. Splenomegaly. Crackles and wheezing.
ECG commonly used in pediatrics. Alarms can be set to detect abnormal heart rates. (leads are color coded; white/right, black/left, green or red for ground lead which usually goes on the abdomen.)
Echocardiography high-frequency sound waves to produce an image of the hearts structure. This test is noninvasive, painless and associated with no known side effects.
Cardiac catheterization invasive diagnostic procedure in which a radiopaque catheter is inserted through a peripheral blood vessel (usually the femoral vein) into the right side of the heart.
CXR provides information on heart size and pulmonary blood flow patterns as well as pulmonary edema
What drug give (per orders) help improve efficiency of the heart? Digitalis Glycosides (Digoxin), increases cardiac output, which decreases heart size, decreases venous pressure, and relieves edema.
Infants = >90-110 beats/min. Older children= >70 beats/min. Withhold medication (digoxin if pulse rate falls below.
Digoxin Good to Knows (Pediatrics) Given per orders. Count Apical pulse for full minute prior to administration. Monitor Serum K+ levels. Give doses in regular intervals (usually 12 hours). Do not mix with food. Miss dose? Past 4 hours wait til next dose. Under 4 hours? ASAP. Vomit? Stop
What is pulmonary artery banding? Through a thoracotomy, a strip of woven prosthetic material is passed around the pulmonary artery to constrict it.
Why would you want to minimize crying? Because it can be too tiring for the child and may cause cyanosis due to exhaustion.
Atrial Septal Defect (ASD) abnormal openings between the atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right atrium.
Three types of ASD Ostium Primum (ASD 1) -Ostium Secundum (ASD 2) -Sinus venosus defect.
Ostium Primum ASD 1. Opening at lower end of septum. May be associated with mitral valve abnormalities.
Ostium Secundum ASD 2. Opening near center of septum.
Sinus Venous Defect Opening near junction of superior vena cava and right atrium. May be associated with partial anomalous venous connection.
ASD Pathophysiology At birth: pressure in left atrium exceeds that in right atrium, causing blood to flow from left to right (left to right shunt). Oxygenated blood is forced from left atrium (high pressure) to right atrium (low pressure), re-circulates through the lungs.
ASD Manifestations May be asymptomatic. Systolic murmur heard over left inter-costal space. Pulmonary congestion (left-sided heart failure).
ASD Tx Surgical Dacron Patch Closure or Median Sternotomy (open repair) with cardiopulmonary bypass is usually performed before school age.
Ventricular Septal Defect (VSD) abnormal opening between the right and left ventricles (intraventricular septum).
Created by: jtzuetrong